- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,772.81 / $2,195.42 / $3,380.67
| Facility | | $1,772.81 | $2,195.42 | $3,380.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,715.68 / $2,155.63 / $3,395.04
| Professional | | $1,715.68 | $2,155.63 | $3,395.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,464.00 / $7,363.00 / $13,012.00
| Facility | | $4,464.00 | $7,363.00 | $13,012.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,860.46 / $2,485.35 / $3,892.41
| Professional | | $1,860.46 | $2,485.35 | $3,892.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,208.58 / $1,453.83 / $2,725.75
| Facility | | $1,208.58 | $1,453.83 | $2,725.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,102.04 / $3,093.06 / $4,643.94
| Professional | | $2,102.04 | $3,093.06 | $4,643.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,912.00 / $6,231.00 / $11,869.99
| Facility | | $2,912.00 | $6,231.00 | $11,869.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,079.73 / $2,837.22 / $4,914.38
| Professional | | $2,079.73 | $2,837.22 | $4,914.38 |